This piercing is typically fitted with a 14, 16, or 18 gauge labret,[2][3] the bars of which are usually shortened after healing. A variation on this piercing is Angelbites - a double version of a this piercing with both the Madonna and Monroe style piercings worn on either side of the upper lip. This piercing may also be referred to as a Crayfish, Beezy piercing, Angel Bites, or Anti Bites, being the anti version of snake bites. When long barbells are worn in this piercing, they look similar to the antennae on a crayfish, hence the name.[4] Most people with a Monroe piercing favor a metal ball or a jewel on the outer-end.[citation needed] The lip can often swell considerably after the piercing and will need both facial and oral aftercare to keep both sides of the jewelry clean at all times. Monroes, like all piercings, are prone to infection and it is vital that the piercing is cleaned regularly. Scarring is minimal to none if properly taken care of.

An advantage of a monroe piercing is that the lip area generally heals faster than other piercings. The estimated healing time given by professional piercers for this type of lip piercing is between 8–12 weeks,[3] but many find it heals in 3–6 weeks.[2]

The monroe can be a very painful piercing process, as this area of the body contains a large system of nerves. There is a small risk of piercing the superior labial artery, which lies just above the upper lip.

The amount of pain experienced during the piercing process differs from person to person and depends on the specific location of the piercing. Those with thicker lips or well-exercised facial muscles will have more flesh or muscle to pierce,[3] so they may experience more discomfort. Men may experience slightly more pain than women, as repeated shaving can make the skin of the upper lip tougher and harder to pierce. The orbicularis oris (the sphincter muscle around the mouth) is used in the playing of brass and woodwind instruments; as a result, players of these instruments tend to have a larger muscle around the mouth and may experience more discomfort during the piercing process.

As with similar piercings, monroes can cause long-term damage to the gums and teeth. The back-disk of metal jewellery worn in this piercing rubs against them, potentially resulting in gum recession or damage to tooth enamel. Plastic labret-studs are available to minimize this problem.